- CVS Health (Hartford, CT)
- …time zone) with occasional weekends and holidays on a rotation schedule. The Appeals Nurse Consultant position is responsible for processing the medical ... a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,...Utilization Review experience - Medicare experience - Managed Care Appeals experience **Education** Associate 's degree or RN… more
- CVS Health (Hartford, CT)
- …we do it all with heart, each and every day. **Position Summary** The Appeals Nurse Consultant position is responsible for processing the medical necessity of ... Medicare Part C appeals from both members and providers. This role is...a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include,… more
- CVS Health (Hartford, CT)
- …business hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity ... + Managed Care experience + Utilization Management experience + Coding experience + Appeals experience **Education** + Associate 's Degree minimum OR Diploma RN… more
- CVS Health (Columbus, OH)
- …care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to apply appropriate clinical ... with internal and external support areas. **Required Qualifications** + A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- US Tech Solutions (RI)
- …12:00 am CST; possible weekends** **Duration: 6 Months +** **Job Description:** + The Nurse Associate LPN - Prior Authorization is responsible for the efficient, ... to all callers through the criteria-based process. + The Nurse Associate LPN will follow criteria question...the type of request and create, route, and/or complete appeals or requests in accordance with department processes. Process… more
- Commonwealth Care Alliance (Springfield, MA)
- …intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) serves as an integral member of an interdisciplinary team for medical ... needs of the defined panel of members, the Registered Nurse will engage in regular assessments, visits at regularly...as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and… more
- Ascension Health (Pensacola, FL)
- …related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . + Assess and coordinate discharge planning needs with ... regulations. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained prior to… more
- Ascension Health (Baltimore, MD)
- …related to coding, medical records/documentation, precertification, reimbursement and claim denials/ appeals . + Assess and coordinate discharge planning needs with ... and regulations. **Requirements** Licensure / Certification / Registration: + Registered Nurse credentialed from the Maryland Board of Nursing obtained prior to… more
- Mount Sinai Health System (New York, NY)
- …for appeals , On / Off-site Insurance reviews + Implements first step of appeals process to assist Appeals Nurse and Enter Denial information in ... experience may be considered in lieu of educational requirements: Associate Degree + Strong clerical skills required + Very...Discharge Appeals / Insurance requests) + Support Appeals Nurse / Manager by confirming status… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... semester credits) + Some College (90-120+ semester credits) + Associate 's Degree + Bachelor's Degree + Master's Degree or...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... semester credits) + Some College (90-120+ semester credits) + Associate 's Degree + Bachelor's Degree + Master's Degree or...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- Clark County, NV (Las Vegas, NV)
- …in the union. MINIMUM REQUIREMENTS Education and Experience: Equivalent to an Associate 's Degree and two (2) years of general public service experience, one ... retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and...semester credits) + Some College (90-120+ semester credits) + Associate 's Degree + Bachelor's Degree + Master's Degree or… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …cycle teams. The UM Analyst helps ensure regulatory compliance, timely appeals , and reduction of avoidable denials through proactive collaboration and data-driven ... Collaborate with UM staff to draft and submit compelling clinical appeals , including summaries and supporting documentation in accordance with payer-specific… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... semester credits) + Some College (90-120+ semester credits) + Associate 's Degree + Bachelor's Degree + Master's Degree or...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- State of Colorado (Denver, CO)
- …unlicensed staff member who operates under the supervision of a licensed nurse within Nursing Services. This position is generally responsible for utilizing ... Education: Graduation from an accredited college or university with an Associate 's degree in psychology, sociology, social work, behavioral science, clinical mental… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... semester credits) + Some College (90-120+ semester credits) + Associate 's Degree + Bachelor's Degree + Master's Degree or...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... semester credits) + Some College (90-120+ semester credits) + Associate 's Degree + Bachelor's Degree + Master's Degree or...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... semester credits) + Some College (90-120+ semester credits) + Associate 's Degree + Bachelor's Degree + Master's Degree or...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... semester credits) + Some College (90-120+ semester credits) + Associate 's Degree + Bachelor's Degree + Master's Degree or...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more
- Clark County, NV (Las Vegas, NV)
- …Pharmacy Benefits (30, 90-day retail or mail order fills) + 24/7 Telephone Advice Nurse - no employee cost + Teledoc, Doctoroo, and Dispatch Health + Retiree ... semester credits) + Some College (90-120+ semester credits) + Associate 's Degree + Bachelor's Degree + Master's Degree or...applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. +… more